Medicare Advantage vs. Medigap: Which Is Right for You?

Almost every Medicare question people bring me is really this one wearing a disguise. Once you have Part A and Part B, you choose one of two structures for receiving your benefits, and nearly everything downstream — what you pay, which doctors you can see, whether coverage travels — follows from that single fork.

Neither is the right answer in general. Anyone who tells you otherwise is selling something. What follows is what actually separates them, including the parts that are inconvenient for whichever side you might be leaning toward.

The two structures, briefly

A Medicare Advantage plan (Part C) is a private plan that delivers your Part A and Part B benefits. One card, one plan, usually with prescription drug coverage folded in, and often extras like dental, vision and hearing. You keep paying your Part B premium — $202.90 a month at the standard rate in 2026 — plus whatever the plan itself charges, which is frequently nothing.

A Medicare Supplement, usually called Medigap, works alongside Original Medicare instead of replacing it. Medicare pays first, the supplement pays most of what Medicare leaves behind. There is no network. You add a standalone Part D plan for prescriptions, because Medigap policies sold today never include them.

That “no network” line is the single biggest practical difference, and it is worth being precise about why.

Where your money actually goes

The comparison people usually make is premium against premium, and it is close to meaningless. A plan with a $0 premium and $6,000 of possible exposure is not automatically cheaper than one with a $180 premium and almost none. What matters is the whole year.

On Medicare Advantage

You pay the $202.90 Part B premium, plus the plan premium if it has one, and then you pay as you go: a copay for the primary care visit, a larger one for the specialist, something for the imaging, something per day for a hospital stay. Every plan sets its own amounts.

The protection is the annual out-of-pocket maximum. Once you hit it, the plan covers the rest of the year. That cap is the most important number on any Advantage plan and the one most people never look at — they compare premiums and extras, and skip the figure that decides what a bad year costs.

On Medigap plus Part D

You pay the $202.90 Part B premium, the supplement premium, and a Part D premium. Then, on the most common plan design, you pay the 2026 Part B deductible of $283 and essentially nothing else for Medicare-covered services. Not for the specialist, not for the imaging, not for the hospital stay.

That is what the monthly premium buys: the near-elimination of variable costs.

The crossover

For somebody who sees a doctor three times a year, Advantage usually wins on total cost, often comfortably. For somebody managing two chronic conditions with regular specialist visits, Medigap frequently wins despite the higher premium, because copays accumulate faster than premiums do.

The annual cost estimator will run your own numbers through both structures using 2026 federal figures. Run it twice — once for a normal year, once for a bad one with an admission in it. If the answer flips between those two runs, that tells you something no average ever will.

Networks: the part that decides it for most people

A Medigap policy has no network. If a provider accepts Medicare, they accept your supplement. Any specialist, any hospital, any state, no referrals.

A Medicare Advantage plan has a network, and the network is the plan. This is not a footnote — it is the mechanism by which the plan can afford to charge you nothing monthly.

Three things about networks that catch people out:

Networks change every January. The cardiologist who is in-network this year may not be next year. Nobody calls to tell you; it arrives in the Annual Notice of Change, a document written to be filed rather than read.

HMO and PPO behave very differently. An HMO generally covers you only in-network except for emergencies, and often requires referrals. A PPO covers out-of-network care at a higher cost share. If you want an Advantage plan and you travel, a PPO is usually the only version worth discussing.

“Accepts Medicare” and “in your plan’s network” are different statements. A practice can accept Medicare and still be out-of-network for your specific Advantage plan. Asking a receptionist “do you take Medicare?” does not answer the question. The question is “are you in-network for [plan name]?”

Around Anthem this matters more than it might elsewhere. Most residents drive to Deer Valley, Norterra or Scottsdale for specialist care, and the networks are drawn around specific hospital systems. Which plan reaches your cardiologist is a genuinely local question — one reason the service area pages exist.

Travel, snowbirds and split years

If you spend part of the year outside Arizona, this is close to decisive.

Medigap travels without qualification. Care in Michigan in July is treated exactly like care in Anthem in January.

Medicare Advantage covers emergency and urgent care nationwide, always. Routine care outside the service area depends on the plan — a PPO may cover it at out-of-network rates, an HMO generally will not. Getting a routine specialist follow-up done while you are away can range from straightforward to impossible depending on which plan you hold.

If you split the year, say so early. It reshapes the whole comparison.

The deadline that only runs one way

Here is the asymmetry that gets buried, and the reason this decision is more time-sensitive than it looks.

Getting into Medicare Advantage is always easy. Advantage plans cannot turn you down for health reasons. You can join during your Initial Enrollment Period, during the Annual Enrollment Period each autumn, or during a Special Enrollment Period. Health is never a factor.

Getting into Medigap is easy exactly once. Your Medigap open enrollment period runs six months from the first day of the month in which you are both 65 and enrolled in Part B. Inside it, no carrier can refuse you or charge you more because of your health. Outside it, in Arizona, they can medically underwrite — and they do.

So the two paths are not symmetrical. Choosing Advantage at 65 and moving to Medigap at 72 means passing underwriting at 72, with whatever has happened to your health in between. Choosing Medigap at 65 and moving to Advantage at 72 is trivial.

That is not an argument for Medigap. Plenty of people are better served by an Advantage plan and should take one. It is an argument for making the choice deliberately rather than by default, while both doors are open. The enrollment window checker will tell you exactly when yours closes.

Extras, and how much weight to give them

Advantage plans commonly include dental, vision, hearing and fitness benefits. Medigap includes none of it.

These are real and worth something, particularly hearing aids, which are expensive and not covered by Original Medicare at all. But two cautions:

An allowance is not full coverage. A dental benefit that covers cleanings may cover very little of a crown. Read what the number actually buys before it moves your decision.

And extras are the wrong tiebreaker if the plan fails the network test. A plan that costs you your specialist is not redeemed by a fitness membership.

Prescriptions cut across both

Most Advantage plans include Part D. Medigap always needs a separate one.

Either way, the drug side deserves its own analysis, because formularies vary enormously between plans whose premiums look identical. Two plans four dollars apart in premium can differ by several hundred dollars a year on the same medication list, purely because one puts a common generic on a higher tier.

The 2026 Part D out-of-pocket cap is $2,100. Once your spending on covered drugs reaches it, the plan covers them fully for the rest of the year. That cap is a genuine improvement — and it makes plan choice more consequential, not less, because when you reach it depends entirely on how your plan tiers your drugs. Details are in Part D explained.

Higher income changes both

If your modified adjusted gross income on your 2024 return was above $109,000 filing single or $218,000 filing jointly, you pay an income-related surcharge on Part B and Part D in 2026. It applies on both paths and is not avoidable by choosing one over the other.

It does affect the arithmetic, though, because it raises the fixed cost of both columns. See IRMAA explained, or run your own figure through the IRMAA estimator.

The short version

Medigap tends to fit when you want to keep specific doctors, when you travel or split the year, when you use care regularly, when you would rather pay a predictable premium than variable copays, and when you are inside your one-time open enrollment window.

Medicare Advantage tends to fit when holding down monthly cost matters, when you do not use a great deal of care, when your doctors are already in the network, and when bundled dental, vision and hearing are worth real money to you.

Tendencies, not rules. The plan type finder will tell you which way your own answers point and, more usefully, what would change the answer.

What to have ready

Whoever you talk to, the conversation is only as good as the details you bring:

• Every doctor you want to keep, by name. Including the specialist you see once a year — that one usually eliminates a plan.
• Your prescriptions with dosages, and your pharmacy. Not “a blood pressure pill” — the name and the milligrams.
• Whether you travel or spend months out of state.
• Anything scheduled in the next twelve months. A planned knee replacement moves the answer a long way.
• Where you are in your enrollment windows, especially the Medigap one.

With those five things, one conversation does the work of three vague ones — and the answer stops being general and starts being yours.